Diken Adem I, Yalçınkaya Adnan, Hanedan Muhammet O, Erol Mehmet E, Ercen Diken Özlem
1 Hitit University Faculty of Medicine, Cardiovascular Surgery, Çorum, Turkey.
2 Ahi Evren Thorax, Heart and Vascular Education and Training Hospital, Cardiovascular Surgery, Trabzon, Turkey.
Phlebology. 2018 Feb;33(1):53-59. doi: 10.1177/0268355516688358. Epub 2017 Jan 6.
Background Standard treatment for deep venous thromboembolism involves parenteral anticoagulation overlapping with a vitamin K antagonist, an approach that is effective but associated with limitations including the need for frequent coagulation monitoring. The direct oral anticoagulant rivaroxaban is similarly effective to standard therapy as a single-drug treatment for venous thromboembolism and does not require routine coagulation monitoring. The aim of this analysis was to project the long-term costs and outcomes for rivaroxaban compared to standard of care (tinzaparin/warfarin). Methods A total of 184 patients who were under anticoagulant therapy with warfarin or rivaroxaban for extended deep venous thromboembolism were retrospectively evaluated; 59 received rivaroxaban and 125 received warfarin therapy. Assessments were made on age, gender, place of residence, the duration of anticoagulation, mean international normalized ratio value, the effective rate of international normalized ratio (time in the therapeutic range), bleeding-related complication rate, duration of hospitalization due to complications, the number of annual outpatient department admission, cost for drug, cost for hospitalization, cost for outpatient department admission and international normalized ratio measurements. Results The annual outpatient cost is higher in warfarin group (147.09 ± 78 vs. 62.32 ± 19.79 USD p < 0.001). But annual drug cost is higher in rivaroxaban group (362.6 vs. 71.55 ± 31.01 USD p < 0.001). Overall cost of rivaroxaban group is higher than warfarin group (476.25 ± 36.78 vs. 364.82 ± 174.44 USD). Warfarin is not cost-effective when non-drug costs (342.5 ± 174.44 vs. 113.65 ± 36.77) and hospital costs (173.85 ± 122.73 vs. 64.9 ± 23.55 USD) were analyzed. Conclusion This analysis suggests that rivaroxaban has lower costs than warfarin in terms of outpatient department admission and hospital costs due to complications; however, warfarin was more economic when all cost parameters were considered. Time in the therapeutic range was found as 56% for warfarin that should be taken into account while analyzing costs and benefits.
背景 深静脉血栓栓塞的标准治疗包括胃肠外抗凝与维生素K拮抗剂重叠使用，这种方法有效，但存在包括需要频繁进行凝血监测等局限性。直接口服抗凝剂利伐沙班作为静脉血栓栓塞的单一药物治疗与标准治疗同样有效，且不需要常规凝血监测。本分析的目的是预测与标准治疗（替扎肝素/华法林）相比，利伐沙班的长期成本和结果。方法 对总共184例接受华法林或利伐沙班抗凝治疗以治疗广泛性深静脉血栓栓塞的患者进行回顾性评估；59例接受利伐沙班治疗，125例接受华法林治疗。对年龄、性别、居住地点、抗凝持续时间、平均国际标准化比值、国际标准化比值的有效率（治疗范围内的时间）、出血相关并发症发生率、因并发症住院的持续时间、每年门诊就诊次数、药物成本、住院成本、门诊就诊成本和国际标准化比值测量进行评估。结果 华法林组的年度门诊成本更高（147.09±78对62.32±19.79美元，p<0.001）。但利伐沙班组的年度药物成本更高（362.6对71.55±31.01美元，p<0.001）。利伐沙班组的总体成本高于华法林组（476.25±36.78对364.82±174.44美元）。当分析非药物成本（342.5±174.44对113.65±36.77）和医院成本（173.85±122.73对64.9±23.55美元）时，华法林不具有成本效益。结论 该分析表明，就因并发症导致的门诊就诊和医院成本而言，利伐沙班低于华法林；然而，当考虑所有成本参数时，华法林更具经济性。发现华法林在治疗范围内的时间为56%，在分析成本和效益时应予以考虑。
